disease, presenting a combination of the symptoms of both scarlatina and measles. Not a simple combination, however, in which each of these diseases maintains throughout its individuality, the one succeeding the other without being confounded with it, but an actual fusion of the two. The characteristics of the one may seem to predominate, and it is evidently under the control of the other. The morbid phenomena which are present in the mucous tissue indicate the coexistence and co-operation of the two morbific elements of scarlatina and measles, while the phenomena which the skin presents, prove their reciprocal modifying influence. The eruption being not exactly that appertaining properly to either of the two diseases, but of both of which it has some of the characteristics. (Vide Gintrac's Cours. Théor, et Clin. de Pathol. Interne, etc., 1859.) In scarlatina the eruption is uniform over the whole body; or occurs in large, irregular blotches, not elevated above the surface; or with many miliaria-like papulæ. The mucous membrane of the organs of deglutition affected, that of the organs of respiration primarily unaffected. Desquamation of cuticle generally in large lamina or patches. Consecutive diseases principally parotitis and anasarca. In rubeola or scarlet rash, which Dr. Engelman believes to be a transition form of disease from scarlatina to measles, the eruption is in spots, generally large, of an irregular, angular shape, of a high color, elevated above the surface; the redness disappearing under pressure, and generally reappearing first in the circumference. Mucous membrane of the organs of deglutition, respiration, and vision affectedangina, cough, and coryza present. Desquamation furfuraceous and slight; often none at all. Consecutive diseases the same as those of scarlatina or measles, according as the character of the exanthem approaches the one or the other. In morbilli or measles the eruption is in spots, generally smaller than in roseola circular, or somewhat angular, of a paler rose color, elevated above the surface only in the centre, the redness appearing there first after pressure is removed. Mucous membranes of respiration and vision affected; those of deglutition not. Desquamation furfuraceous, generally slight, or entirely absent. Consecutive diseases always affections of the chest-pleuritis with exudation; pneumonia or asthma. Roseola, we would remark, is an exanthem of red patches scattered over the surface of the body; it is preceded by fever, but is unattended with any special affection of the mucous membrane. In its acute form, it is liable, occasionally, to be confounded with the milder forms of scarlatina or measles. The diagnosis will seldom, however, be attended with difficulty if a careful comparison of the symptoms of roseola with those of scarlatina and measles be instituted. 4. Variola-Smallpox. This "loathsome malady," though no longer the same scourge of infancy as it was previous to the discovery of vaccination, is still of sufficient frequency to demand our close attention. Notwithstanding the means for its entire extirpation is within the reach of every community, yet, from an almost criminal supineness upon the part of our legislative bodies, and ignorance and prejudice on the part of a large portion of the community, it is allowed to prevail, destroying through-out the world many thousands annually, and stamping with deformity the countenances of many of those who are fortunate enough to pass through it without loss of life. Hence, the physician is obliged to make himself fully acquainted with its pathological character, and proper mode of treatment, for he knows not at what moment he may be called upon to watch its progress, and lend his aid to mitigate the sufferings it entails, and, if possible, prevent it destroying those to whom he has not been permitted to afford a certain protection against its attack. Variola is an eruptive fever, marked by the occurrence of pustules over the entire surface of the body, which appear at a definite period, run a regular course, and upon separating in the form of dry crusts, frequently leave a deep and indelible cicatrix. It is propagated by contagion, and often prevails as an epidemic-the first cases not being always traceable to any focus of infection. As a general rule, to which the exceptions are comparatively rare, it affects an individual but once during life. Like other febrile diseases, variola commences with chills, or rigors, succeeded by a febrile reaction, of more or less intensity, which may continue for two or three days before the eruption upon the skin appears. The attack is very generally preceded by pains, more or less intense, in the back and limbs; often, for many days, by some degree of languor or lassitude; the patient feels depressed; his nights are often restless, and his digestion somewhat impaired. This constitutes what has been termed the stage of incubation, the duration of which has been variously stated, as from one to two weeks; to fix its limits is, in most cases, however, impossible. It has been said that the moment of infection is often marked by some disagreeable sensation-giddiness, sickness, or an inward feeling of alarm. We cannot say that we have observed anything of the kind. Frequently the infection remains for a long period latent in the system. We have known an individual to continue in apparent health, in the midst of an epidemic of smallpox, by which nearly every unprotected person in the same dwelling and neighborhood with himself was infected, and after the epidemic had entirely ceased-uo cases occurring for weeks-to be suddenly attacked with the disease. in its most virulent form. Often the period of incubation is marked by no particular symptoms, either of a general or local character. The first indication of infection being a severe long-continued chill, or several slight attacks of rigor, occurring at short and irregular intervals, and speedily followed by a febrile reaction, often of considerable intensity, during which the pulse is quickened, and the skin becomes hot and dry, or disposed to perspiration. The patient often complains of pain, or a sense of soreness in the limbs, and generally of severe pain or a feeling of weakness in the back. There is commonly pain in some part of the head, particularly in the temples and forehead. The child frequently exhibits a degree of drowsiness, and usually awakes.with a start, or in a state of alarm. There is commonly considerable prostration of strength, and, in many cases, an anxious, suffering expression of countenance. In some instances, the attack is marked, in its early stages, by great irritability of stomach, frequent vomiting, oppression at the præcordia, and a pungent pain at the epigastrium, increased upon pressure. Not unfrequently, there occurs considerable difficulty of respiration, with cough, wheezing, and other indications of bronchial or pneumonic disease. Occasionally, the reaction is slight and imperfect; or the disease commences with a state almost approaching to complete collapse; the surface of the body being pale, cold, and relaxed; the pulse feeble, and the countenance anxious and contracted. The eruption is frequently preceded by a severe epileptic paroxysm. Many of the foregoing symptoms may abate in violence, or entirely disappear, upon the occurrence of the eruption, while others continue with greater or less intensity. The eruption upon the skin usually occurs at the end of forty-eight hours from the occurrence of the chill, the pain in the back, or the gastric distress. In delicate subjects, and in those who have been debilitated by loss of blood, long-continued vomiting, or severe purging, or from exposure to cold, the appearance of the eruption is not unfrequently delayed;-its occurrence previous to the third day being, in such cases, extremely rare. The eruption first appears upon the face in the form of small red papulæ, elevated above the surface of the skin. Subsequently, similar papulæ occur on the neck and wrists, and then upon the trunk and thighs, and, finally, upon the feet. By the end of the first or second day the eruption usually extends over the entire surface of the body; but, occasionally, not before the end of the third or fourth day. It is seldom that the eruption occurs to the same extent over every portion of the surface; it is generally most considerable about the folds of the joints, and such parts of the body as are kept permanently warm. In a few instances, it has been known to commence upon some part of the body, or upon the inferior extremities, and occasionally one or two papula may appear about the face, and assume the vesicular form, previously to the occurrence of the general eruption. The papula become rapidly more and more distinct, and by the end of the first day, they are of a decided red color, and sensibly elevated; by the third day, a small vesicle forms upon each papula, filled with a thin transparent fluid, and surrounded with an inflamed circular margin. The vesicle soon becomes depressed in the centre, and so continues until about the sixth day. As the vesicle becomes more completely distended, and of a more globular form, the indentation disappears; the vesicle now assumes a yellowish-white, or pearly appearance, and instead of being filled, as at first, with a transparent fluid, it is now distended with a yellowish puriform matter, of the consistence of cream. When the pustules are numerous, the parts upon which they are situated become swollen, and the surrounding skin assumes a deep red color, from the extension to it of the inflammation. The swelling is usually to the greatest extent in the face, hands, and feet. About the seventh day, some of the pustules on the face burst, and upon the eighth or ninth, they begin to dry, and become converted into scabs; the pustules successively assuming a yellow, then a brown, and, when perfectly dry, a very dark brown, or almost black color. The scab adheres for a few days, and then falls off, leaving, in general, especially upon the face, a deep pit, or depressed cicatrix. The skin usually remains, after the scab falls off, of a dark brown mottled appearance, and it is often many weeks, or even months, before it regains its natural hue. From the appearance of the papulæ, to their complete maturation, there generally intervenes a period of seven days. But as the papulæ do not appear simultaneously upon every part of the surface, their maturation takes place successively; thus, upon the face they assume the pustular form, burst, and are converted into scabs, first; then upon the trunk and the upper extremities; and finally, upon the lower extremities. As many as four or five days may intervene, between the complete maturation of those upon the face, and those upon the feet. During the stage of maturation, the surface of the body emits a sickly, disgusting odor, which is peculiar to the disease. At the period when the eruption appears, the throat generally be comes more or less affected, and most commonly redder than natural; in severe cases, it is often considerably inflamed, and frequently cov ered with aphthous ulcerations. The latter, however, generally precede the eruption on the surface, and often disappear earlier than it. When the inflammation of the throat is extensive, the entire mucous membrane of the respiratory tubes is very liable to be likewise affected. During the eruptive fever, the tongue is generally covered with a thin layer of white mucus; when the eruption is completed, this is partially removed, and, at its tip, a few eruptions usually appear. It is commonly moist, excepting when the patient is confined to a close and impure atmosphere, when it may become dry and dark-colored. With the complete maturation of the eruption, the febrile symptoms in general subside or entirely disappear: frequently, however, some degree of febrile excitement continues, until scabs are formed over the greater part of the surface. When the eruption is at its height, there is always more or less tenderness of the skin, which is so considerable in some cases, as to occasion great distress to the patient. Frequently, there is considerable itching of the surface, which causes the patient, unless restrained, to scratch and rupture the vesicles, by which, generally, his suffering, as well as the danger of deformity, from deep, large, and irregular cicatrices, is increased. When the eruption is finished, there is, very commonly, some degree of salivation, in consequence of the affection of the mucous membrane of the mouth and fauces. The bowels are usually constipated throughout the disease. Sometimes, however, they are affected with more or less diarrhoea, which occasionally results from some degree of inflammation of the ileum and colon. The extent of the eruption is very various; in some cases only a few papulæ appear, scattered over different parts of the body, which run their course, and are converted into pustules, that dry and fall off, without any further affection of the skin. In other cases, although the eruption occupies the greater portion of the surface, each pustule remains distinct and separate from the others; in other cases, again, they are very numerous, and so close together as to run one into the other. The first two constitute the distinct smallpox of medical writers, and the last the confluent. The violence of the disease is generally in proportion to the extent of the eruption upon the skin. Thus in the confluent form, all the precursory symptoms are more severe; the eruptive fever is more intense; the difficulty of respiration, and the pain and uneasiness at the epigastrium, greater; convulsions and delirium are likewise more common than in the distinct form. There is also more danger, from the intense inflammation by which it is attended, of extensive sloughing or ulceration of the skin; while, in general, the affection of the throat and respiratory mucous membrane is more extensive and more liable to give rise to troublesome and dangerous complications. There is still another form of smallpox-the congestive; in which the reaction is incomplete or absent. The patient labors under symptoms of severe oppression, and great difficulty of respiration; his surface is cold, his pulse feeble; the eruption is slow in appearing, seldom very extensive, and when vesicles form, these are flat, flaccid, and never properly mature. The severity of the febrile symptoms during the stage of maturation, we have said, is always in proportion to the number of pustules. Their intensity is also in some degree influenced by the condition of the patient, and certain external circumstances. Thus, in persons of a healthy, but not plethoric constitution, of a tranquil disposition and temperate habits, occupying large, cool, and well-ventilated apartments, and subjected to a proper diet and regimen, the eruption, although extensive, may maturate with the occurrence of only a moderate degree of febrile excitement. Under opposite circumstances, even a less amount of eruption may be attended by severe fever, and other unfavorable symptoms. The Considerable attention has been paid, by modern observers, to the structure, or anatomical characters of the variolous vesicle. inflamed spot with which the eruption commences is seated in the cutis vera. It commences at a central point, spreads by radiation on the surface, and penetrates to a greater or less depth in different cases. A substance of a pulpy consistence, forming a kind of pseudo-membranous layer, is secreted immediately beneath the epidermis, which |